July 21, 2011

The Obstacles and Gifts of ADHD

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Joseph V. Madia, MD By:

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Adult attention deficit disorders very manageable

It wasn't until her son was diagnosed with attention-deficit disorder (ADD) that Sandra Vitallo had a label for all the things she'd been feeling since childhood.

Finally, at 33, she stopped "self medicating" with diet pills, got on appropriate medication and started to accept that her attention problems were actually gifts.

ADD and attention deficit hyperactivity disorder (ADHD) used to be considered something that affected only children. Today, it's understood that millions of adults are challenged with a mental and physical restlessness that can affect virtually every areas of their lives.

What exactly is attention deficit hyperactivity disorder?

ADHD is caused by chemical imbalances in the brain. These chemicals, called neurotransmitters, behave differently in people this attention disorders. The condition is usually inherited, and while there's no cure for ADHD, it can usually be well managed.

ADHD affects an estimated 10 million people in the United States.

How do you know if you might have ADHD?

"ADHD is very individualized," says Dulce Torres, a licensed professional counselor in the Dallas/Fort Worth, Texas area who has been specializing in treating ADHD for more than 15 years. She says how people experience the disorder varies widely, ranging from mild symptoms to severe impairments that can touch all areas of life including school, career, home life, relationships and day-to-day activities.

Here are some of the major symptoms of ADHD:

  • Difficulty paying attention - easily distracted
  • Physical restlessness - difficulty staying in one position - hyperactivity
  • Impulsiveness - talking or acting before thinking
  • Procrastination - generally waiting until the last minute to get things done
  • Trouble starting and finishing tasks or projects
  • Problems with organizing, planning (sequencing) and managing time
  • Frequently forgetting or losing things

What are the different types of ADHD?

There are three major types (subtypes) of ADHD:

  • Primarily Inattentive - struggles with attention, organization and following through
  • Primarily Hyperactive/Impulsive - problems with impulsiveness, restlessness and control
  • Combined Subtype - difficulties with attention, impulsivity and restlessness

Sandra has the inattentive type. "It's very difficult for me to read. It's hard to focus, and it's also difficult to listen to someone who's not interesting - I'll go off into another world."

When should you think about getting help?

ADHD can be disruptive, interfering with important areas of your life. Here are signs of struggles you don't want to ignore:

Career

  • Trouble keeping a job because of poor, inconsistent performance
  • Quitting jobs frequently
  • Working in positions that don't meet your intellectual abilities or match your skills

Everyday tasks and responsibilities

  • Having difficulty staying on top of the so-called "tasks of daily living"
  • Difficulty starting and finishing household chores
  • Trouble organizing and keeping track of your stuff
  • Not paying bills on time

Relationships

  • Getting upset over minor issues
  • Forgetting important dates
  • Difficulty accomplishing tasks and everyday chores
  • Having problems communicating

Emotional distress

  • Constant worry over not getting things done or taking care of your responsibilities
  • Ongoing feelings of guilt, blame or frustration

Where you can go for help?

Torres says, "ADHD can mimic other disorders including anxiety and depression. That's why it's very, very important to go to a licensed clinician - an experienced professional who knows about mental health issues and ADHD."  She adds that an experienced professional can sort through various mental health issues to arrive at an accurate diagnosis.

To find a qualified professional, ask your doctor to refer you to someone who can perform an evaluation for adult ADHD. Or you may want to attend an ADHD support group to ask for references. The "Professional Directory" link below is a tool for finding professionals in your area.

Qualified ADHD assessment professionals include licensed mental health professional such as clinical social workers, licensed professional counselors and clinical psychologists. You will need to be under the care of a physician - either a psychiatrist, physician's assistant, family doctor or neurologist to get medications that are often prescribed to treat ADHD.

How is ADHD diagnosed?

Each clinician goes about the diagnosis process slightly differently. Some may ask you to complete and return questionnaires before your first visit. You might also be asked to bring old school records.

The most important element is your openness and willingness to discuss whatever is bothering you. Many people with ADHD live with feelings of shame and fear of criticism because they've been judged - sometimes harshly - by others perhaps for a very long time.

To get the right help, it's really important to let the professional you're dealing with know what's up with you.

A thorough ADHD assessment will include some or all of the following:

  • Diagnostic interview during which you'll be asked a number of questions to establish your history and current situation, including any particularly troubling issues
  • Review of any other mental health problems you have had or currently have. Rarely does ADHD occur alone. Most adults have other conditions that could include everything from anxiety disorders and learning disabilities to substance abuse
  • Feedback from a significant other (spouse, family member, partner) to provide history, perspective and to learn how your behaviors impact others
  • Standardized behavior rating scales, which usually include checklists of symptoms you experience; you and your significant other may be asked to complete these
  • Additional tests may be needed to identify and address other issues
  • Medical exam may also be required to evaluate your overall physical health

Overcoming the obstacles

ADHD is easily managed with medication and some sort of counseling support.

Psychostimulants are most often used to treat ADHD. They stimulate the central nervous system and have a calming effect on people with ADHD. Only physicians and physician assistants can prescribe these medicines.

The most common ADHD medications are:

Psychostimulants

  • Ritalin, Concerta, Metadate, Daytrana (methylphenidate)
  • Focalin (dexmethylphenidate)
  • Adderall (amphetamine-Dextroamphetamine)
  • Dexedrine, Dextrostat (dextroamphetamine)
  • Vyvanse (lisdexamfetamine)

Most of these are oral medications that come in short- and long-acting forms. Daytrana comes in a patch that's applied daily to the hip.

Other medications

  • Strattera (altomoxetine) - a non-stimulant
  • Wellbutrin (bupropion), tricyclics - antidepressants sometimes prescribed for other conditions
  • Catapres, Tenex (alpha-2 agonists)

Finding the right medicine and dosing sometimes takes a while to finalize. That's why you'll want to have a good relationship with a medical professional who can work with you.

Other therapies

Torres, who has a private therapy practice and also provides coaching services, says that cognitive behavioral therapy works really well with people who are living with ADHD. This therapy helps people learn new ways of thinking and behaving that enable them to overcome the limitations ADHD may be imposing on them.

Successful treatment, Torres says, involves several factors. "People need to accept the diagnosis and to become educated about ADHD so they understand how it affects them," she says.

"Then they need to educate the people in their lives, not as an excuse, but so that others understand the disorder, too. It's a team effort," she says.

The gifts

Sandra is a South Texas entrepreneur who owns several successful small businesses. The multitasker says, "I do in a day what most people get done in a week, and I'll do in a week what it takes other people a month to do."

"They are the most creative people I know," says Torres. "And they are also among the smartest people, who have a lot to offer the world."

Sandra agrees. Her creativity ranges from drawing and painting to designing and promoting large events. "I've been able to use my gifts to turn them into businesses."

So Sandra sees her ADHD as a blessing in many ways. "The main thing is I can make a living with it. For all the time I heard 'you're not good enough' or 'you're not smart enough,' today I feel just as good or maybe better than someone who has a college degree."

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
July 20, 2011

Last Updated:
October 2, 2012